The MAGAZINE of the Johns Hopkins Bloomberg School of Public HealthSpring 2010 | www.jhsph.edu

Death on the Road

Story by Jim Schnabel

Because road crashes aren’t diseases, they haven’t always been seen as a public health issue. But there is no disputing their impact. About once every second on average, they injure someone; about twice per minute, they kill. Even in the U.S., they are one of the leading causes of death, and in the developing world their toll is much higher. Worldwide, road crashes claim more than 1.2 million lives every year.

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In December, the Bloomberg Philanthropies announced that it would fund a $125 million, 5-year Global Road Safety Program. A consortium led by WHO will launch projects in 10 countries targeting some of the main factors that lead to crash casualties: driving too fast, driving without a seatbelt or child restraint, driving a motorcycle without a helmet, and driving drunk.

Public education campaigns will be an important aspect of the interventions. But, says Hyder, “education alone has not been found to make huge impacts in the absence of specific interventions and law enforcement, so enforcement is key.” WHO representatives therefore will work with local law enforcement ministries, as well as with legislatures to add or tighten safety laws. Improving the availability of helmets, seatbelts and child restraints in some of the target countries will also be part of the program.

The crucial task of Hyder and the IIRU is to find out which of these interventions are effective. “We need to know the situations in these countries at the outset, and to see how they change after the program’s interventions are applied,” he says.

A related challenge is to make the driving experience safer regardless of driver and pedestrian behavior. “Engineering roads and cars to protect people is just as important in developing countries as it has been here in the U.S.,” says injury prevention expert Susan Baker. “It can be very tempting, for example, to build roads to enable higher speeds, but then not to build dividers to keep opposing streams of traffic from colliding.”

Baker, a pioneer of road safety studies, points out that the cultural change leading to better driver behavior can take a long time, and typically requires stricter law enforcement, while engineering efforts see immediate results. “Enforcement has to be done 365 days a year,” she says, “while engineering approaches have to be done only once.”